Informed consent, informed refusal, informed choice--what is it that makes a patient's medical treatment decisions informed?

Informed consent is the fundamental ethical and legal doctrine that protects the patient's rights of personal autonomy and bodily self-determination. An adjunct to the doctrine of informed consent advanced by some is the notion of informed refusal. According to advocates of this concept, incoherent, unconscious, or otherwise incapacitated patients cannot make informed treatment choices because such patients cannot receive a full and current explanation of their health problems and treatment options. This, in turn, raises serious questions about what it is that makes a patient's treatment decisions--whether consents or refusals--informed. Is current, detailed information about the patient's medical condition and treatment options an ethical and legal prerequisite? Can non-medical values and concerns of the patient ever suffice to make the patient's treatment choices informed? How does the concept of informed refusal affect the use of health-care advance directives? This paper will address these important questions.